寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的临床效果

目的讨论寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的手术指征、技术特点及临床疗效。方法采用寰枢椎椎弓根螺钉植入治疗30例寰枢椎不稳及脱位患者,其中男性22例,女性8例;平均43.5岁,病程1周~16年。30例患者均存在不同程度颈部疼痛、活动受限等症状;22例伴不同程度四肢感觉和运动障碍;4例先天性游离齿状突、8例齿状突陈旧性骨折及7例横韧带断裂的患者行后路植骨。结果所有患者未出现脊髓或椎动脉损伤、无断钉等严重并发症,术后伤口无感染,X线检查提示寰枢椎的解剖关系得到恢复。术后3个月神经功能获得不同程度的改善;术后6~18个月,X线及三维CT提示:获得骨性融合;随访中,螺钉未出现松动、断裂,位置满意。结论在对寰枢椎不稳及脱位的治疗上,寰枢椎椎弓根螺钉技术能有效重建寰枢椎的稳定性,提高融合率,是一种值得推广、安全可靠的治疗手段。

Clinical effect of pedicle screw internal fixation system in treating atlantoaxial instability and dislocation

Objective To evaluate the indication,technical characteristics and clinical efficiency of the utili-zation of pedicle screw internal fixation system for atlantoaxial instability and dislocation.Methods Thirty patients with atlantoaxial instability and dislocation were treated with pedical screw internal fixation system, including 22 males and 8 females,with an average age of 43.5 years.The disease course ranged from one week to 16 years.All 30 pa-tients had inordinately cervical pain and limitation of cervical movement,moreover,22 patients had inordinately sensory and motor disorders of extremities.Four patients with congenital odontoid disconnection,eight patients with old frac-ture of odontoid process and seven patients with transverse ligament rupture were treated with auto-bone graft for fusion through posterior approach.Results There was no serious complication such as spinal cord injury,vertebral artery injury and screws broken.No wound infection was observed.X ray examination showed that the atlantoaxial anatomy structure was restored among all the patients.Neurological function had improved inordinately after 3 months postoper-atively.From X ray and CT examination,the bone fusion was achieved after 6-18 months of follow-up.There was no case with screws related complications.All the screws were in position at each follow-up.Conclusion The technol-ogy of pedical screw internal fixation system can reconstruct the atlantoaxial stability and improve the fusion rate effec-tively when used for the treatment of the atlantoaxial instability and dislocation.The low incidence of complications in-dicates that the pedical screw internal fixation system is a safe and reliable treatment method.